Testing a breast cancer prevention and a multiple disease prevention weight loss programme amongst women within the UK NHS breast screening programme—a randomised feasibility study

Abstract

Background Excess weight and unhealthy behaviours (e.g. sedentariness, high alcohol) are common amongst women including those attending breast screening. These factors increase the risk of breast cancer and other diseases. We tested the feasibility and acceptability of a weight loss/behaviour change programme framed to reduce breast cancer risk (breast cancer prevention programme, BCPP) compared to one framed to reduce risk of breast cancer, cardiovascular disease (CVD) and diabetes (T2D) (multiple disease prevention programme, MDPP). Methods Women aged 47-73 years with overweight or obesity (n = 1356) in the NHS Breast Screening Programme (NHSBSP) were randomised (1:2) to be invited to join a BCPP or a MDPP. The BCPP included personalised information on breast cancer risk and a web and phone weight loss/behaviour change intervention. The MDPP also included an NHS Health Check (lipids, blood pressure, HbA1c and personalised feedback for risk of CVD [QRISK2] and T2D [QDiabetes and HbA1c]). Primary outcomes were uptake and retention and other feasibility outcomes which include intervention fidelity and prevalence of high CVD and T2D risk. Secondary outcomes included change in weight. Results The BCPP and MDPP had comparable rates of uptake: 45/508 (9%) vs. 81/848 (10%) and 12-month retention; 33/45 (73%) vs. 53/81 (65%). Both programmes had a high fidelity of delivery with receipt of mean (95% CI) 90 (88-98% of scheduled calls, 91 (86-95%) of scheduled e-mails and 89 (76-102) website entries per woman over the 12-month period. The MDPP identified 15% of women with a previously unknown 10-year CVD QRISK2 of ≥ 10% and 56% with 10-year Qdiabetes risk of ≥ 10%. Both groups experienced good comparable weight loss: BCPP 26/45 (58%) and MDPP 46/81 (57%) with greater than 5% weight loss at 12 months using baseline observation carried forward imputation. Conclusions Both programmes appeared feasible. The MDPP identified previously unknown CVD and T2D risk factors but does not appear to increase engagement with behaviour change beyond a standard BCPP amongst women attending breast screening. A future definitive effectiveness trial of BCPP is supported by acceptable uptake and retention, and good weight loss. Trial registration ISRCTN91372184, registered 28 September 2014.

What do women think about having received their breast cancer risk as part of a risk-stratified NHS Breast Screening Programme? A qualitative study

“…Similarly, women who previously received 10-year breast cancer estimates were more likely to report changes to diet, alcohol consumption and physical activity if they self-reported being high risk [ 35 ]. Offering specific interventions such as programmes focused on weight loss or weight gain prevention appear to be beneficial for women at higher risk of breast cancer [ 36 – 39 ]. The findings in the present study suggest it may also be feasible to prevent weight gain in women at lower risk of breast cancer given they reported the desire to maintain this level of risk.…”

How do women who are informed that they are at increased risk of breast cancer appraise their risk? A systematic review of qualitative research

“…For these women a multiple disease prevention programme (MDPP) whereby preventative behaviours (i.e. increasing physical activity and maintaining a healthy diet) associated with reducing the risk of multiple diseases may be more appropriate than a prevention programme linked to breast cancer risk alone [ 48 , 49 ]. However when compared to a Breast Cancer Prevention Programme (BCPP) a MDPP showed no significant improvements in physical activity and diet, indicating that perhaps a MDPP would only be appropriate in a minority of cases [ 48 , 49 ] as this review suggests.…”

The Second Nutrition and Cancer Networking Meeting Nutrition and Breast Cancer: Translating Evidence into Practice

“…Importantly, the participants attempting to adapt to this dramatic dietary change are supported by trained advisors. Work presented by Dr Michelle Harvie (University of Manchester) demonstrated how community-based outreach interventions can actively and effectively support patients to bring their BMI towards a healthy range following treatment, which consequently improves both functional and mental health (9) . Having patient support processes inbuilt as part of trial design, and co-designing trials with patient representatives, should optimise adherence and retention rates.…”